This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 5 May 2009

Ginny did not get her pain medication on time. Why?

"The night nurses managed to give the morphine on time. The day nurses managed it. But that horrible, evil little shit of a late shift nurses did not. What a fucking bitch. They should get rid of that horrible Amy, the late shift nurse"

More dumbass comments from people who don't have a fucking clue.

Amy is just as good as the nurses who preceded her but she ended up in a hell of a situation on that Tuesday afternoon.

See, the night shift from Monday into Tuesday had 2 staff nurses and had an extra in the form of a student nurse. It was relatively quiet. Most of the patients were stable and waiting for discharge on Tuesday. The nurses could cope. There were two staff nurses on the ward which actually enabled the nurses to access the controlled drugs that were due every 4 hours at least for the the cancer patient, Ginny.

Fast forward to Tuesday morning. The day shift comes on. They are so lucky today. They have mostly stable patients waiting for discharge and there are 2 staff nurses and 3 care assistants. 2 and 3. Not great staffing numbers but survivable. You need at least 5 staff nurses on a day shift easily for 30 beds but we never ever get that. At least with 2 they can access the controlled drugs. Two nurses and mostly stable patients for the morning.

Here comes the late shift. Amy starts her late shift at 1PM. The medically stable discharges are going home and before the nurses have a chance to clean the beds, new patients come.

These new ones are unstable acutely ill patients with pages of orders, IV drugs, etc and they are coming through the door a couple at a time. They were rushed up here and they are in mess. The nurse who was looking after them down on medical A&E hold didn't have time to sort a thing so the ward nurse has to pick it up. These patients need almost one to one support. It is not safe to leave them for any length of time.

There were 9 discharges and there are 9 of new admits in total and they all arrive in groups of 2-3 between 1PM and 1:30 Pm. Amy is just getting out of report at 1:30 where she listened to overwhelming amounts of info about the other 15 patients she is caring for on this late shift.. A&E is desperate to meet their targets and these new patients are being brought up in a group . They were getting into the lift before the 9 discharges were even out the door.

There is another twist. Amy will be working as the only staff nurse this afternoon. Usually we have 2. The other nurse who was supposed to be working with her is upstairs on another ward with endocarditis and management hasn't allowed anyone to replace her on this shift. They don't want to pay for bank or agency or pool nurses. Amy has to carry this alone. The day shift nurses cannot stay on. They have stayed onto extra hell shifts before, only to end up in the shit basically. Our husbands are all threatening to leave us for staying onto extra shifts, unpaid, causing husband to have to walk out of work early to pick up the children from the childminders. My husband used to have to do this twice a week when our kids were little. It's amazing that he did not get fired. I was always having to stay onto unplanned additional and unpaid hours after the end of my regularly scheduled shifts due to unforseen circumstances on the ward. He hasn't dumped me or got the sack yet, but it has affected his career. These goddamn fucking childminders sure as hell won't work before 0830 or after 6Pm, or weekends and holidays. And they charge you for picking your kids up late.

"Never ever marry a staff nurse unless you can afford built in childcare in your house 24/7" says Mr. Militant Medical Nurse as he stands here reading over my shoulder.

So here we have one nurse and some very acutely ill patients plus many other dependent patients for the late shift. The number of sick patients increases and the number of nurses decrease. Happens all the fucking time. As there is no way to control the number of patients coming into the hospital, there is no way to plan staffing. A childminder knows exactly how many babies she will be looking after. Nobody suddenly doubles her number of charges without any warning, and takes her help away. This is normal every day stuff on medical wards.

Night shift came onto relieve Amy at 9PM. So we were back to two nurses again. Finally, Ginny could get her controlled drugs without Amy having to wait for a nurse from another ward be able to leave her patients and leg it to our ward. Amy had to stay on for 2 hours unpaid to finish her documentation.

Amy didn't have a chance in hell of being able to get those controlled drugs out to the cancer patient in time. But the nurses in the preceding and the succeeding shifts absolutely did. They got it done, and Amy didn't. And after that hellish shift she got slammed as the "bad one".

If we have 10 feeds on the ward we get 2 nurses and 3 care assistants maximum.

If we have 2 feeds the staffing numbers don't change. If it suddenly increases to 18 feeds on the ward, the staffing numbers do not change. We do not have the right to additional help. We are just responsible for any bad outcomes.

If we have all healthy easy patients we get 2 staff nurses and 3 care assistants maximum. If all 30 are crashing out and trying to die we still only get 2 staff nurses and 3 care assistants maximum, maybe less.

Say we have all healthy, mobile patients on one shift, and then on another shift we have all very sick ones . The staffing numbers do not alter, except to reduce.

We can have any kind of random set up: Lots of sick patients and our maximumn of 2 and 3 for one shift. Another shift has very little in the way of really sick patients but we have 3 and 3. The next shift has the sickest patients they have seen all week yet that shift only has 2 and 1. The next shift is so so and they have 2 and 2. Or maybe we get all easy patients and we luck out with 3 and 3 and two students. Maybe we only have 2 and 1 but we have easy patients so we cope and the families think that we are so much nicer than those horrible nurses last week. Um. We are the same nurses who were here last week and we were on our knees. But thanks for the attempt at a compliment. It's in god's hands it seems. And we all know that God hates nurses.

The workload can reduce or triple in an instant with no warning, yet the staffing numbers never really change.

This is real life on the general wards. What I am describing here is real and it happens all the time, all over the place, in most hospitals. THIS IS WHY WE ARE LOSING ALL OF OUR NURSES. IT'S A FUCKING CRISIS. WHO CAN WORK IN THESE CONDITIONS? WHAT I DESCRIBE ON THIS BLOG IS NORMAL. IF THE NURSES WERE NOT SO HARDWORKING AND CARING AND DID NOT SUCK UP THIS ABUSE ALL THE TIME THE PATIENTS WOULD BE 100 TIMES WORSE OFF THEN THEY ARE RIGHT NOW!! WHAT I AM DESCRIBING HERE IS WHY WE ARE LOSING GOOD NURSES ALL THE TIME AND WHY THEY ARE RUNNING AWAY INTO CLIPBOARD CARRYING MANAGEMENT POSITIONS.

Why can't management always give us great staffing numbers? That way when the shit hits the fan we would be able to cope.

I'll tell you why.

They are so afraid that on those rare, easy days, when we have all stable easy patients, that some nurse, somewhere, might actually have time to sit and hold a dying man's hand because she has nothing else to do. They fear idleness. If a nurse has time to help a patient then she must be idle. And if a nurse has time to sit and hold someone's hand that means that there are too many nurses on the ward and that staff needs to go. This is how hospital managers think. This is not just a problem in the NHS. I have worked outside of the NHS. The staffing levels are worse in the NHS but the general attitudes and incompetence of those who manage hospitals are a massive problem everywhere.

7 comments:

According to these studies this kind of opioids narcotics should be legalized as they consume to improve quality of life of people suffering from chronic pain and suffering, it is important that this announcement has given the International Association of Cannabis as a medicine as it indicates findrxonline the methods in use and the characteristics of each.

Yeah welcome to America. Staffing is a result of money management. Profit is king. Hospitals are a business. You want a job? I've seen idle nurses, they don't go "hold a dying man's hand." They sit in the lounge and eat, they sit at the end of the hall and update facebook on their cells, they sit and talk about how the other nurse is an idiot and the other shifts suck. Especially those older, bitter nurses.

Ӏt’s very informative and yοu're obviously really experienced in this field. You have got opened my own eye for you to varying views on this particular matter along with intriquing, notable and reliable content.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.